64排螺旋CT支气管动脉成像的临床研究
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摘要
第一部分支气管动脉的CT解剖分型
目的：探讨基于64排螺旋CT血管成像（CTA）的支气管动脉（BA）解剖分型及其临床应用价值。
资料与方法：使用136例患者的动脉期CT增强扫描数据进行容积再现（VR）、最大密度投影（MIP）、多平面重组（MPR）重建，获得BA三维重建图像并将其分为6型，同时了解BA起始端的三维定位信息。
结果：BA共计显示358支，其中188支右BA，170支左BA。R1L1型者占50%（68/136），R2L1型者占24%（33/136）。在BA的解剖分型中，右BA常见于I型（77/188，41%）；左BA多见于IV型（110/170，65%）。100%（77/77）I型，59%（32/54）II型和100%（9/9）V型BA起源于胸主动脉右壁，83%（40/48）III型和56%（62/110）IV型BA起源于胸主动脉前壁。BA胸主动脉起始端位于气管隆突上下2cm范围内者有255个开口，占86%（255/298）。
结论：支气管动脉的CT解剖分型结合其胸主动脉起始端的三维定位信息，对介入放射医师快速准确地实施支气管动脉介入手术具有重要指导意义。
第二部分回顾性心电门控-支气管动脉CT成像的前瞻性研究
目的：分组使用回顾性心电门控和常规螺旋CT扫描技术进行支气管动脉CTA，探究其在BA显示率和成像质量等方面的差异。
资料与方法：根据本研究的纳入标准和排除标准，120例行胸部肺动脉期增强CT检查的患者入组本研究，所有患者均签署知情同意书。按随机数字表将患者分为3组，每组40例。A组使用回顾性心电门控扫描技术，时间分辨率为227ms；B组和C组使用64排螺旋CT扫描技术，扫描速度分别为0.4s/r和0.5s/r。将BA分为纵隔段和叶段，一位医师使用多平面重组、曲面重组等后处理技术，观察各级BA的显示情况，计算其显示率。二位医师对纵隔段BA的成像质量进行独立评分，使用4分~0分的五级评分标准，评分为4分或3分者定义为确定为（成像质量）优或良。采用χ2检验/Kruskal-wallis秩和检验比较BA显示率和成像质量的组间差异。另外，比较肺动脉及胸主动脉强化CT值、CT辐射剂量等的组间差异。
结果：①.A组纵隔段和叶BA的显示率分别为100%（80/80）和62%（123/200），明显高于B组和C组。经Kappa一致性检验，医师间和医师内的纵隔段BA成像质量评分结果高度一致，Kappa值分别为0.80和0.84。A组BA成像优良率为69%（66/95），明显高于B组和C组。A组肺动脉期扫描的平均有效剂量为15.6mSv，明显高于B组（8mSv）和C组（8mSv），增加96%的辐射剂量。②. B组纵隔段和叶BA的显示率分别为89%（71/80）和33%（66/200），明显高于C组的69%（55/80）和15%（29/200）。B组BA成像优良率为36%（30/84），明显高于C组的17%（11/63）。其平均扫描时间为3.2s，仅为A组（9s）的36%。
结论：回顾性心电门控-支气管动脉CTA可获得很好的显示率和图像质量，缺点是有效剂量大。使用0.4s/r的64排螺旋CT扫描，BA显示率和图像质量居中，优点是有效剂量低和扫描时间短，适用于咯血等急诊患者支气管动脉CTA检查。
Part one. The Anatomical CT Classification of Bronchial Artery
Object: To evaluate anatomical classification of bronchial artery with64-detector CTangiography and its clinical value.
Materials and Methods:136patients underwent CT angiography of bronchialarteries (BAs) using volume rendering (VR), multiplanar reconstruction (MPR) andmaximum intensity projection (MIP). The three dimensional reformation images were usedfor anatomical classification of BA (six types). Spatial localizing data of BA ostia atthoracic aorta was measured simultaneously.
Results: We identified358BAs:188right BAs and170left BAs. R1L1and R2L1BA patterns accounted for50%(68/136) and24%(33/136) respectively. The right BAswere commonly seen in type I (77/188,41%), while the left BAs were mostly seen in typeIV (110/170,65%). BAs originated from the right wall of the thoracic aorta were seen intype I, type II and type V with frequencies of100%(77/77),59%(32/54) and100%(9/9),respectively. BAs arised from the anterior wall were seen in type III and type IV withpercentages of83%(40/48) and56%(62/110). There were86%(255/298) BAs ostiaoriginating at thoracic aorta within range of±2cm from tracheal bifurcation.
Conclusion: The CT classification of BAs combines with their ostia localizing dataplay an important part in BA interventional operation.
Part Two. Bronchial Artery Angiography with Retrospective ECG-gatedCT: A Prospective Study
Object: To evaluate the rate of bronchial artery (BA) visualization and their imagequality with retrospective ECG-gated CT, compared with routine spiral CT scanninggroups.
Materials and Methods: All patients gave written informed consent.120cases whounderwent pulmonary arterial enhancement scanning (PAES) were enrolled, according todesigned inclusion and exclusion criteria. They were randomly divided into three groups.Retrospective ECG-gated BA-CTA was used in Group A, which temporal resolution was227ms. Routine spiral CT scanning was used in Group B and Group C, which gantryrotation speed was0.4s/r and0.5s/r respectively. Bronchial arteries were divided intomediastinal BA and lobar BA. Two blinded observers independently assessed imagequality of mediastinal BAs by using a five point scale (score4~0). A score of4or3wasdifined as good image quality. Inter-group difference in enhancement CT value ofpulmonary and thoracic artery, CT effective doses etc. was compared.
Results:①. The frequency of visualized mediastinal and lobar BA in Group A were100%(80/80) and62%(123/200) respectively, which was higher than Group B and GroupC. Theκstatistics of inter-and intraobserver agreement for evoluation of the image qualitywere0.80and0.84, respectively. The agreement analysis for image quality of mediatinalBA demonstrated obviously identicalκstatistics. The rate of good image quality for per-BAwas69%(66/95) in group A, which was much higher than Group B and C. The averageeffective dose (ED) of PAES in Group A was15.6mSv,96%higher than that in Group Band C.②. The rate of visualized mediastinal and lobar BA were89%(71/80) and33%(66/200) respectively, which was higher than Group C. The rate of good image quality forper-BA was36%(30/84) in Group B, which was much higher than group C. The averagesanning time was3.2s in Group B,36%of that in Group A (9.0s).
Conclusion: There were satisfactory visualization and good image qualiy of BA with retrospective ECG-gated CT angiography, expect larger ED. There were a fair visualizationrate and image quality in use of0.4s/r spiral scanning that was fastest speed of LightSpeedVCT, because of its lower ED and faster scanning time. So, it is applicable in emergencyBA-CTA for patients of hemoptysis.
目的：探讨基于64排螺旋CT血管成像（CTA）的支气管动脉（BA）解剖分型及其临床应用价值。
资料与方法：使用136例患者的动脉期CT增强扫描数据进行容积再现（VR）、最大密度投影（MIP）、多平面重组（MPR）重建，获得BA三维重建图像并将其分为6型，同时了解BA起始端的三维定位信息。
结果：BA共计显示358支，其中188支右BA，170支左BA。R1L1型者占50%（68/136），R2L1型者占24%（33/136）。在BA的解剖分型中，右BA常见于I型（77/188，41%）；左BA多见于IV型（110/170，65%）。100%（77/77）I型，59%（32/54）II型和100%（9/9）V型BA起源于胸主动脉右壁，83%（40/48）III型和56%（62/110）IV型BA起源于胸主动脉前壁。BA胸主动脉起始端位于气管隆突上下2cm范围内者有255个开口，占86%（255/298）。
结论：支气管动脉的CT解剖分型结合其胸主动脉起始端的三维定位信息，对介入放射医师快速准确地实施支气管动脉介入手术具有重要指导意义。
第二部分回顾性心电门控-支气管动脉CT成像的前瞻性研究
目的：分组使用回顾性心电门控和常规螺旋CT扫描技术进行支气管动脉CTA，探究其在BA显示率和成像质量等方面的差异。
资料与方法：根据本研究的纳入标准和排除标准，120例行胸部肺动脉期增强CT检查的患者入组本研究，所有患者均签署知情同意书。按随机数字表将患者分为3组，每组40例。A组使用回顾性心电门控扫描技术，时间分辨率为227ms；B组和C组使用64排螺旋CT扫描技术，扫描速度分别为0.4s/r和0.5s/r。将BA分为纵隔段和叶段，一位医师使用多平面重组、曲面重组等后处理技术，观察各级BA的显示情况，计算其显示率。二位医师对纵隔段BA的成像质量进行独立评分，使用4分~0分的五级评分标准，评分为4分或3分者定义为确定为（成像质量）优或良。采用χ2检验/Kruskal-wallis秩和检验比较BA显示率和成像质量的组间差异。另外，比较肺动脉及胸主动脉强化CT值、CT辐射剂量等的组间差异。
结果：①.A组纵隔段和叶BA的显示率分别为100%（80/80）和62%（123/200），明显高于B组和C组。经Kappa一致性检验，医师间和医师内的纵隔段BA成像质量评分结果高度一致，Kappa值分别为0.80和0.84。A组BA成像优良率为69%（66/95），明显高于B组和C组。A组肺动脉期扫描的平均有效剂量为15.6mSv，明显高于B组（8mSv）和C组（8mSv），增加96%的辐射剂量。②. B组纵隔段和叶BA的显示率分别为89%（71/80）和33%（66/200），明显高于C组的69%（55/80）和15%（29/200）。B组BA成像优良率为36%（30/84），明显高于C组的17%（11/63）。其平均扫描时间为3.2s，仅为A组（9s）的36%。
结论：回顾性心电门控-支气管动脉CTA可获得很好的显示率和图像质量，缺点是有效剂量大。使用0.4s/r的64排螺旋CT扫描，BA显示率和图像质量居中，优点是有效剂量低和扫描时间短，适用于咯血等急诊患者支气管动脉CTA检查。
Part one. The Anatomical CT Classification of Bronchial Artery
Object: To evaluate anatomical classification of bronchial artery with64-detector CTangiography and its clinical value.
Materials and Methods:136patients underwent CT angiography of bronchialarteries (BAs) using volume rendering (VR), multiplanar reconstruction (MPR) andmaximum intensity projection (MIP). The three dimensional reformation images were usedfor anatomical classification of BA (six types). Spatial localizing data of BA ostia atthoracic aorta was measured simultaneously.
Results: We identified358BAs:188right BAs and170left BAs. R1L1and R2L1BA patterns accounted for50%(68/136) and24%(33/136) respectively. The right BAswere commonly seen in type I (77/188,41%), while the left BAs were mostly seen in typeIV (110/170,65%). BAs originated from the right wall of the thoracic aorta were seen intype I, type II and type V with frequencies of100%(77/77),59%(32/54) and100%(9/9),respectively. BAs arised from the anterior wall were seen in type III and type IV withpercentages of83%(40/48) and56%(62/110). There were86%(255/298) BAs ostiaoriginating at thoracic aorta within range of±2cm from tracheal bifurcation.
Conclusion: The CT classification of BAs combines with their ostia localizing dataplay an important part in BA interventional operation.
Part Two. Bronchial Artery Angiography with Retrospective ECG-gatedCT: A Prospective Study
Object: To evaluate the rate of bronchial artery (BA) visualization and their imagequality with retrospective ECG-gated CT, compared with routine spiral CT scanninggroups.
Materials and Methods: All patients gave written informed consent.120cases whounderwent pulmonary arterial enhancement scanning (PAES) were enrolled, according todesigned inclusion and exclusion criteria. They were randomly divided into three groups.Retrospective ECG-gated BA-CTA was used in Group A, which temporal resolution was227ms. Routine spiral CT scanning was used in Group B and Group C, which gantryrotation speed was0.4s/r and0.5s/r respectively. Bronchial arteries were divided intomediastinal BA and lobar BA. Two blinded observers independently assessed imagequality of mediastinal BAs by using a five point scale (score4~0). A score of4or3wasdifined as good image quality. Inter-group difference in enhancement CT value ofpulmonary and thoracic artery, CT effective doses etc. was compared.
Results:①. The frequency of visualized mediastinal and lobar BA in Group A were100%(80/80) and62%(123/200) respectively, which was higher than Group B and GroupC. Theκstatistics of inter-and intraobserver agreement for evoluation of the image qualitywere0.80and0.84, respectively. The agreement analysis for image quality of mediatinalBA demonstrated obviously identicalκstatistics. The rate of good image quality for per-BAwas69%(66/95) in group A, which was much higher than Group B and C. The averageeffective dose (ED) of PAES in Group A was15.6mSv,96%higher than that in Group Band C.②. The rate of visualized mediastinal and lobar BA were89%(71/80) and33%(66/200) respectively, which was higher than Group C. The rate of good image quality forper-BA was36%(30/84) in Group B, which was much higher than group C. The averagesanning time was3.2s in Group B,36%of that in Group A (9.0s).
Conclusion: There were satisfactory visualization and good image qualiy of BA with retrospective ECG-gated CT angiography, expect larger ED. There were a fair visualizationrate and image quality in use of0.4s/r spiral scanning that was fastest speed of LightSpeedVCT, because of its lower ED and faster scanning time. So, it is applicable in emergencyBA-CTA for patients of hemoptysis.
引文
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[10]Remy-Jardin M, Bouaziz N, Dumont P, et al. Bronchial and nonbronchial systemic arteries at multi-detector row CT angiography:comparison with conventional angiography. Radiology.,2004,233(3):741-749.
[11]Ziyawudong J, Kawai N, Sato M, et al. Aortic ostia of the bronchial arteries and tracheal bifurcation:MDCT analysis. World J Radiol,2012,4(1):29-35.
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